URMC Compliance Program Policy Manual:
Skilled Nursing Facilities

In 1987 the federal Nursing Home Reform Act imposed requirements for nursing facilities certified under the Medicaid program. As Medicaid participating facilities, the URMC skilled nursing facilities comply with these requirements. The law sets out standards for the quality of life for the residents of nursing facilities, the services that must be provided to them, the way their personal funds must be handled, and their rights in a variety of areas. The nursing facility must provide each resident with an assessment and plan of care. There is a civil penalty of up to $1,000 for willfully and knowingly making a material false statement in a resident assessment and a civil penalty of up to $5,000 for willfully and knowingly causing another person to make a false statement.

The Medicaid nursing facility requirements are enforced by the Medicaid agency as well as the federal government. Survey units provide information to state Medicaid fraud and abuse control units. The Medicaid agency conducts surveys of nursing facilities. If it finds that a nursing facility does not meet Medicaid standards, the available remedies range from monitoring and denial of certain payments, to termination of Medicaid participation, civil monetary penalties up to $10,000 per day of noncompliance, or transfer of residents to other facilities. If a staff member is aware of a deficiency in a URMC nursing facility, he or she should promptly bring the deficiency to the attention of the facility's administrator or the Compliance Officer so it may be corrected.

New York law also sets licensing standards for nursing homes. URMC is committed to conscientious adherence to state and federal licensing requirements and to the dignity of each nursing home resident.